TCM0202080 - Passported benefits - exemption / health costs: Exemption certificates - health costs
Checklist
Before you follow this guidance make sure
- you have the correct user roles to follow this guidance.
- you are in the correct MU. For how to do this, use TCM0322460.
Background
HM Revenue & Customs (HMRC) provides the NHS Business Services Authority (NHS BSA) (part of the Department of Health) with details of all families who are entitled to help with health costs.
The details passed to the NHS BSA are
- customer NINO
- customer title
- customer forename and surname
- customer address
- children details (surname, forenames, date of birth).
This information is passed to the NHS BSA on a monthly basis.
It should not take more than eight weeks from the date HMRC processes the tax credits claim to the date the customer receives their exemption certificate from the NHS BSA.
Note: If the personal details for the customer and children are not in the correct format, their data will be rejected by NHS BSA and the family will not receive an exemption certificate.
Note: The NHS BSA does not have any facility to amend or change the customer’s details. The NHS BSA does not hold or have access to any other customer details other than those previously stated.
Note: Each tax year, the earnings threshold to qualify for an exemption certificate may change. The details of the earnings threshold are:
2003-2004 - £14,200
2004-2005 - £14,600
2005-2006 - £15,050
2006-2007 - £15,050
2007-2008 - £15,050
2008-2009 - £15,050
2009-2010 - £15,276
2010-2011 - £15,276
2011-2012 - £15,276
2012-2013 - £15,276
2013-2014 - £15,276
2014-2015 - £15,276
2015-2016 - £15,276
2016-2017 - £15,276
Guidance
Note: When sending customer, staff or process data to another individual or team, make sure you follow the latest data security guidelines or contact the Data Guardian/Data security Team for advice.
Step 1
Check what the query is regarding Exemption Certificates.
If the customer is querying whether their entitlement to tax credits qualifies them to get an exemption certificate, go to Step 2.
If the customer has not yet received their exemption certificate, go to Step 2.
If the customer has received an exemption certificate but feels that they are not entitled to this, go to Step 4.
If the customer is awaiting the outcome of an appeal, go to Step 15.
If the customer is reporting a lost exemption certificate, go to Step 16.
If the customer has received more than one exemption certificate, go to Step 17.
If the customer suspects that their identity might have been hijacked, go to Step 17.
Note: If correspondence is received from the NHS Business Services Authority (NHS BSA) advising that the post has been returned undelivered or that the addressee has gone away, follow the guidance in TCM0184200.
Step 2
Check that the personal details of the customer are correct. For how to do this, use TCM1000249.
If the personal details need amending, go to Step 3.
If the personal details are correct, go to Step 4.
Step 3
Amend the personal details for the customer and their children in the correct format. Follow the guidance in TCM0134280.
- go to Step 4.
Step 4
Check that the customer’s income and employment details are correct. For how to do this, use TCM1000249.
If the customer’s income details need amending, go to Step 5.
If the customer’s income details are correct, go to Step 6.
Step 5
Amend the customer’s income and employment details. For how to do this, use TCM1000364 and TCM1000201.
- go to Step 6.
Step 6
If the household gross income is higher than the earnings threshold, go to Step 7.
If the household gross income is below the earnings threshold, go to Step 8.
Step 7
- advise the customer that they are not entitled to an exemption certificate
- any exemption certificate previously issued based on an incorrect level of income should be returned (This content has been withheld because of exemptions in the Freedom of Information Act 2000)
Note: Depending on their circumstances the customer may be able to claim help through the NHS Low Income Scheme. They can get a claim form HC1 from the local Jobcentre Plus or phone 0300 330 1343. - update the Household Notes, for how to do this, use TCM1000001
- take no further action.
Step 8
If the family is receiving both WTC and CTC, go to Step 10.
If the family is receiving WTC with a disability element, go to Step 10.
If the family is receiving CTC only, go to Step 10.
If none of these criteria apply, go to Step 9.
Step 9
- advise the customer that they are not entitled to an exemption certificate
Note: Depending on their circumstances the customer may be able to claim help through the NHS Low Income Scheme. They can get a claim form HC1 from the local Jobcentre Plus or phone 0300 330 1343. - update the Household Notes, for how to do this, use TCM1000001
- take no further action.
Step 10
Check if the family is in receipt of IS, JSA(IB), ESA(IR) or Pension Credit - Guarantee Credit (PC-GC). For how to do this, use TCM1000249.
If any of these benefits are being received, go to Step 11.
If none of these benefits are being received, go to Step 12.
Step 11
- advise the customer that they are not entitled to an exemption certificate
Note: If the customer is in receipt of IS, JSA(IB), ESA(IR) or PC-GC the customers details will not be passed over to the NHS BSA by HMRC. DWP is responsible for the exemption certificate in these cases.
Note: Depending on their circumstances the customer may be able to claim help through the NHS Low Income Scheme. They can get a claim form HC1 from the local Jobcentre Plus or phone 0300 330 1343. - update the Household Notes, for how to do this, use TCM1000001.
- take no further action.
Step 12
Check the date of the award issued to the customer which entitled them to receive an exemption certificate. For how to do this, use TCM1000427.
Note: It should not take more than eight weeks from the date HMRC processes the tax credits claim to the date the customer receives their exemption certificate from the NHS BSA.
If eight weeks have passed since the award notice was issued, go to Step 13.
If eight weeks have not passed since the award notice was issued, go to Step 14.
Step 13
- advise customer to contact the NHS Business Services Authority(This content has been withheld because of exemptions in the Freedom of Information Act 2000) phone 0300 330 1347
- update the Household Notes, for how to do this, use TCM1000001
- take no further action.
Step 14
Note: Where a customer is entitled to receive an exemption certificate but they have not yet received it, the customer is able to use their tax credits award notice as proof of entitlement.
- ask the customer to phone again once eight weeks have passed, if they have not received their exemption certificate by then
- refer customer to leaflet HC11 which explains how they can sign the NHS treatment forms to say they are exempt. The HC11 is a NHS BSA form. NHS BSA can be contacted by phoning 0300 330 1347
- update the Household Notes, for how to do this, use TCM1000001
- take no further action.
Step 15
- advise the customer that their NHS charges will have to be paid until the appeal is decided
- they should get receipts when they pay for treatment
- advise that if the appeal decision agrees that they are entitled to an exemption certificate they will be able to reclaim any health costs paid
Note: Prescription charges refunds should be reclaimed using form FP57 (WP57 in Wales), and other health costs by using form HC5. These forms are obtained from the NHS BSA by phoning 0300 330 1347 or on line. The form and receipts should be sent within 3 months to the NHS Business Services Authority(This content has been withheld because of exemptions in the Freedom of Information Act 2000) If the claim is made over 3 months the customer will need to provide an explanation for the delay. - update the Household Notes, for how to do this, use TCM1000001
- take no further action.
Step 16
Note: Customers do not normally need to report this loss to the police.
- advise the customer to inform the NHS BSA of the loss by writing to the NHS Business Services Authority(This content has been withheld because of exemptions in the Freedom of Information Act 2000)
- the NHS BSA will issue a duplicate exemption certificate
- update the Household Notes, for how to do this, use TCM1000001
- take no further action.
Step 17
- tell the customer to return the exemption certificate (This content has been withheld because of exemptions in the Freedom of Information Act 2000)
- record the details of the conversation in the Household Notes, for how to do this, use TCM1000001
Note: You must follow the guidance in TCM0152060 when you record the note. - complete form TC648 (This content has been withheld because of exemptions in the Freedom of Information Act 2000)
- take no further action.